Sitter Application
Step 1 of 7 - Basics
14%
Date Applying:
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Date Format: MM slash DD slash YYYY
Job Position Applying For:
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Positions Interested In:
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On-Call Sitter
Part Time Nanny
Full Time Nanny
Night Nanny
Sunday School Teacher
Daycare Floater
Daycare Assistant
Daycare Lead Teacher
Group Care Assistant
Applicant’s Full Name:
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Cell Phone:
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Current Address
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Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email:
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Years at current address:
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Do you have a valid Driver’s License?
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Yes
No
Do you have a car?
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Yes
No
Car Year
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Car Make
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Car Model
*
Have you had any accidents or driving violations?
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Yes
No
If yes, please explain below.
High School Name
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Did you graduate High School?
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Yes
No
GED
Did or do you attend college and if so, please list the college's name?
What year did you or do you anticipate graduating?
Type of degree you are pursuing?
Major/Minor desired.
Current GPA
How many years of experience do you have working with children in any capacity?
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I am experienced with the following ages:
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Newborn to 9 months
9 months to 24 months
2 to 5 years old
5 to 10 years old
10+ years old
In what capacity do you have childcare experience?
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Private Babysitting
Relatives
Day Care Center
Preschool Teacher
Teacher
Church Nursery
After School Assistant
Camp Counselor
Team Coach
Tutor
Live-in Nanny
Live-out Nanny
Other
If Other, please explain below.
Please check ALL that apply.
Drive a Car
Will Transport Children
Will Assist in Overnight Care
Able to Swim
CPR Certified
First Aid Certified
Will Work Around Animals
Will Work with Parent at Home
Know Sign Language
Speak a Foreign Language
If you speak a Foreign Language, which one?
Are you fluent?
Yes
No
Reference #1:
Full Name:
Home Phone:
Work Phone:
Number of Children Cared For:
Ages of the Children When Hired:
Specific Years Worked with Them:
Reference #2:
Full Name:
Home Phone:
Work Phone:
Number of Children Cared For:
Ages of the Children When Hired:
Specific Years Worked with Them:
Reference #3:
Full Name:
Home Phone:
Work Phone:
Number of Children Cared For:
Ages of the Children When Hired:
Specific Years Worked with Them:
Reference #4:
Full Name:
Home Phone:
Work Phone:
Number of Children Cared For:
Ages of the Children When Hired:
Specific Years Worked with Them:
Date Available to Start
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Date Format: MM slash DD slash YYYY
Days Available
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Monday From
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HH
MM
AM
PM
Monday Until
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HH
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AM
PM
Tuesday From
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AM
PM
Tuesday Until
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HH
MM
AM
PM
Wednesday From
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HH
MM
AM
PM
Wednesday Until
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HH
MM
AM
PM
Thursday From
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HH
MM
AM
PM
Thursday Until
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HH
MM
AM
PM
Friday From
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HH
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AM
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Friday Until
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HH
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AM
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Saturday From
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HH
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AM
PM
Saturday Until
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HH
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AM
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Sunday From
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HH
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AM
PM
Sunday Until
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HH
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AM
PM
How long are you willing to commit?
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6 Months
1 Year
2 Years
How many hours do you desire per week?
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10
15
20
25
35
40
Please describe any scheduling limitations or considerations for the next 12 months. Include current work and/or school schedules.
Please briefly describe some personal interests and hobbies you have.
Would you be comfortable preparing meals for a family?
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Yes
No
Would you be comfortable assisting with housework?
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Yes
No
Please briefly describe the type of caregiver you consider yourself to be. Ex: Lenient, structured, etc.
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How did you hear about Preferred ChildCare, Inc.?
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As a part of our service to our families, we will conduct a criminal background check, a motor vehicle report history, a social security trace, and a sexual offenders check. Do you give us permission to run these checks?
*
Yes
No
By signing below, you certify that these statements are accurate and true. If you are hired by Preferred Childcare, Inc. as a ChildCare Specialist, you agree to notify Preferred Childcare, Inc. if any changes to your contact information are made.
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Today's Date
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Date Format: MM slash DD slash YYYY
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